| NPI | 1194076216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEIL DUCOTE VP Pharmacy 903-600-1376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2025-05-01 |